Empowerment in Service Delivery

The 2004 WDR: Making Services Work for Poor People offers many conclusions, among them that success stories in service delivery often include an empowered public: a public who has voice in policy-making, information about service providers and/or the means to hold them accountable. As Devarajan puts it, "It has to do with [poor people's] relationship with service providers, that they're not passive recipients of services, but rather active participants."

The WDR affirms that client (citizen) empowerment is an important means of improving service delivery; however, its authors indicate that since the process involves a three-pronged compact with service providers and policymakers, empowerment is not the only instrument which can be effective. The WDR suggests that another means to improve service delivery is by creating better incentives offered by policymakers to providers. Says Devarajan, "That's the one part that doesn't involve a greater role for poor people, but it does involve putting poor people at the center."

Traditionally, to ensure and assess quality of service provision, policymakers intervene between poor people and providers, as service provision is often perceived as the responsibility of government. Thus policymakers are meant to be held accountable by poor people, and providers are meant to be held accountable by policymakers. The WDR refers to this pathway as the "long route."

In the "long route", there is room for poor people to influence service providers by having a voice in policy-making, which then puts pressure on the policymakers to hold providers to account. Logically though, with an additional step, taking the "long route" has the potential for breakdown in the system. Jeffrey Hammer, another WDR author, says that in this route, "You don't have the person who is mostly concerned, be it a parent or patient, imposing discipline on the providers."

Asks Devarajan, "What is it about market-like mechanisms that give you some insight into how poor people can participate?" The report identifies two key ways in which empowerment can enhance service delivery directly: through an increase in choice and purchasing power and through community efforts to monitor and evaluate providers.

Offering vouchers is one proven way to improve service delivery by putting more options in the hands of poor people. Vouchers can be a practical way to increase their purchasing power by creating competition among providers and by promoting an environment where client preferences are considered. WDR authors reference a successful voucher program in Bangladesh that increased enrollment of girls in schools. With vouchers in the hands of parents, increasing enrollment of girls meant a school would receive more money. Thus school officials began to accommodate the preferences of girls and their parents by providing female teachers and separate latrines. Hammer remarks, "This (offering schools money through vouchers) was a way of making sure that the provider was sensitive to the needs of the consumer."

Another way that poor people can affect quality of service delivery is through harnessing their social capital and acting as a community. Community monitoring can be a particularly powerful manifestation of collective action. Service provision can often improve if communities and providers have frequent, direct contact. A pertinent example where community monitoring is appropriate is in education services. Here parents are well positioned, often more so than government officials, to monitor school decisions and teacher attendance, and to follow children's progress. In the case of El Salvador's Community Managed School's Program (Educo), parent involvement induced greater student and teacher attendance, along with higher student test scores. These advancements were attributed to giving parents rights over hiring and firing decisions as well as to frequent visits by a monitoring committee, composed partially of parents.

The WDR addresses the fact that every situation is context specific and even though the two previous examples were successful in their particular contexts, the approaches used may not be appropriate for every situation. According to the WDR, "In different sectors and countries, different relationships need strengthening." Thus, its authors recommend "a constellation of solutions," based on three major determining factors: whether a country's politics are pro-poor or clientalistic, whether clients are homogenous or heterogeneous, and whether services are easy or hard to monitor. Some services, such as immunizations, where preferences and clients do not vary, require less client involvement. Depending on the answers to these questions, the WDR explains eight approaches which can improve quality and accountability in service delivery; however, authors note that there still is room for further variation within that framework.

Information is also recognized as critical for poor people's empowerment in the WDR. Without information, poor people do not know about their entitlements, the options available to them, and the varying degrees of service quality. When asked about how the Bank could work to address this problem, Devarajan offered two possible suggestions. He said, i) every Bank project could include a component for getting information to the public about the beneficiaries of the project, and ii) the Bank could seek information, for example through surveys, about quality of service delivery and then publicize it.

Through statistics provided in the WDR, the latter method, publicizing information about poor service delivery, has recently produced one notable outcome which WDR authors reference. In Bangladesh, a number of newspapers publicized the WDR claim that in their country, 74% of doctors in rural areas were not reporting to work. Shortly thereafter, these reports prompted the director of the health department to perform a spot check at a well-known hospital. The director found that 24 out of 28 doctors were not present at the time of his visit, proving the WDR's statistic correct. This absenteeism resulted in even further press articles discussing the problem, and it has since turned into a national, public debate.

Regarding the response to the report thus far and expectations for the future, Devarajan and Hammer both feel optimistic as they reference the Bangladeshi debate and others. They also report having had high level attendees, active and involved at WDR launches, as well as having heard about ministers with marked-up copies of the report. Remarking that for a cynic, he has been pleased thus far, Hammer also adds, "I am hoping that this is a WDR that is used and discussed more than many [others] have been."

Devarajan suggests a follow-up article in six months for a true assessment of the effect the WDR is actually having. As for what he hopes will happen, he says, "We want to change the conversation around service delivery. We want [the people involved] to have a different discussion than they used to. We want them to think about client power and the politics of service delivery."

For more information on the WDR, please see: http://econ.worldbank.org/wdr/wdr2004/

Back to Empowerment Newsletter (Oct./Nov. 2003)